Background:
Dumping syndrome is a recognised complication of bariatric surgeries, characterised by postprandial hyperinsulinemia followed by hypoglycemia. However, first presentation in the postpartum period with severe hypoglycemia is uncommon. Early recognition is important, particularly in women without diabetes. Metabolic changes in the postpartum period, including breastfeeding-related glucose utilisation can exacerbate glycemic instability.
Case 1
A 40-y o woman, G1P1 with a history of sleeve gastrectomy in 2014 followed by gastric bypass in 2021 without diabetes presented in the immediate postpartum period with recurrent symptomatic hypoglycemia, requiring intravenous dextrose infusions. She had experienced symptoms suggestive of hypoglycemia prior to pregnancy but had not sought medical attention.
Continues glucose monitoring, biochemical evaluation and a mixed meal tolerance test were consistent with late dumping syndrome.
Management with dietary modifications and acarbose resulted in clinical improvement.
Case 2
A 32-y o woman, G2P2 with a history of sleeve gastrectomy in 2021 presented two months postpartum with severe hypoglycemia with loss of consciousness. She had no prior history of diabetes and was asymptomatic during pregnancy. Continues glucose monitoring and biochemical, radiological evaluation supported a diagnosis of Dumping syndrome. She commenced on modified diet and semaglutide with ongoing follow up.
Conclusion
Postpartum metabolic changes and breastfeeding may unmask or exacerbate dumping syndrome, causing clinically significant hypoglycemia.
Dumping syndrome should therefore be considered in postpartum women with previous bariatric surgery, regardless of the time elapsed since surgery.
As bariatric surgery becomes increasingly common among women of reproductive age, clinicians should recognize and manage this under-recognised presentation.